Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome

Yeatman, Mark; Caputo, Massimo; Ascione, Raimondo; Ciulli, Franco; Angelini, Gianni D

doi:10.1016/s1010-7940(01)00572-3

Cited by 74 publications

(65 citation statements)

References 20 publications

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“…A standardized OPCAB approach in high-risk patients does not come at a price of less complete revascularization. This is an important aspect that has been highlighted to be a crucial predictor for the long-term outcome [7,8], but has also been reported to be a major argument against OPCAB [11,24,25]. Our findings are supported by Puskas et al [8] who demonstrated feasibility of complete revascularization using OPCAB.…”

Section: Discussionsupporting

confidence: 81%

Off-pump surgery for the poor ventricle?

et al. 2011

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Severely decreased ejection-fraction is an established risk-factor for worse outcome after cardiac surgery. We compare outcomes of off-pump coronary artery bypass grafting (OPCAB) and on-pump CABG (ONCABG) in patients with severely compromised EF. From 2004 to 2009, 478 patients with a decreased EF B35% underwent myocardial-revascularization. Patients received either OPCAB (n = 256) or ONCABG (n = 222). Propensity score (PS), including 50 preoperative risk-factors, was used to balance characteristics between groups. PS adjusted logistic regression analysis was performed to assess mortality and major adverse cardiac and cerebrovascular events (MACCE). A composite endpoint for major non-cardiac complications such as respiratory failure, renal failure, rethoracotomy was applied. Complete revascularization (CR) was assumed when the number of distal anastomoses was larger than that of diseased vessels. There was no difference for mortality (2.3 vs. 4.1%; PS-adjusted odds ratio (PS-OR) = 1.05; p = 0.93) and MACCE (13.7 vs. 17.6%; PS-OR = 1.22; p = 0.50) including myocardial-infarction (1.4 vs. 4.9%; PS-OR = 0.39; p = 0.26), low cardiac output (2.3 vs. 4.7%; PS-OR = 0.75; p = 0.72) and stroke (2.3 vs.2.7%; PS-OR = 0.69; p = 0.66). OPCAB patients presented with a trend to less frequent occurrence of the non-cardiac composite (12.1 vs. 22.1%; PS-OR = 0.54; p = 0.059) including renal dysfunction (PAOR = 0.77; 95% CI 0.31-1.9; p = 0.57), bleeding (PAOR = 0.42; 95% CI 0.14-1.20; p = 0.10) and respiratory failure (PAOR = 0.39; 95% CI 0.05-3.29; p = 0.39). The rate of complete revascularization was similar (92.2 vs. 92.8%; PS-OR = 0.75; p = 0.50). OPCAB in patients with severely decreased EF is safe and feasible. It may even benefit these patients in regard to non-cardiac complications and does not come at cost of less complete revascularization.

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Section: Discussionsupporting

confidence: 81%

Off-pump surgery for the poor ventricle?

et al. 2011

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“…Numerous studies have shown favourable outcomes with OFP surgery in patients with LMS disease (7)(8)(9). Certainly, the uses of stabilizers to steady the heart and intracoronary shunts to permit continued myocardial perfusion during performance of the distal anastomoses have contributed to this.…”

Section: Discussionmentioning

confidence: 99%

“…The studies included in this review have shown better or at least the same outcomes for OFP surgery of patients with LMS disease (8)(9)(10). However, the ROOBY trial involving 2,203 male patients has demonstrated in the whole population (LMS and non-LMS disease) that at 1-year follow-up patients undergoing a beating heart operation experienced worse composite outcomes i.e., mortality, repeat revascularization, or myocardial infarction than did patients in the ONP (28).…”

Section: Controversiesmentioning

confidence: 91%

“…The rates for OFP range between 0% to 1.8% and for ONP between 2.6% to 5% (Figure 1). The majority of these studies were not able to demonstrate a statistically significant difference (9)(10)(11)(12). Freedom from death at 30 days and 1 year has been shown 96.5% and 94.5% for the OFP group and 97.4% and 95.2% for the conventional ONP group, respectively (12).…”

Section: Early Mortalitymentioning

confidence: 99%

“…Yeatman et al (9) showed that OFP surgery required less postoperative inotropic support, less temporary pacing, had lower postoperative transfusion requirements and had reduced incidence of postoperative chest infections when compared to the ONP method. The reduced requirement for transfusion of red blood cells in the OFP, despite similar total blood loss was attributed to the greater haemodilution and increased intraoperative blood loss with CPB.…”

Section: Morbiditymentioning

confidence: 99%

See 2 more Smart Citations

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

Athanasopoulos

Athanasiou

2016

J. Thorac. Dis.

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Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.

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Left Main Coronary Artery Disease

Tamburino

2009

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Off-pump coronary artery bypass surgery for critical left main stem disease: safety, efficacy and outcome

Abstract: OPCAB surgery is safe and effective in patients with critical LMS disease.

Cited by 74 publications

References 20 publications

Off-pump surgery for the poor ventricle?

Off-pump surgery for the poor ventricle?

Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies

Left Main Coronary Artery Disease

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